When a loved one has a drinking problem, it’s hard to know how to help, especially if they are in denial. In this brief guide, experts share best practices.
You suspect your spouse, close friend, or relative has a drinking problem. Or maybe it’s so obvious, you’re shocked they can’t see it.
But they don’t.
And you’re tied up in knots, with no clue what to do. Or, maybe you’ve tried approaching your loved one. Countless times. But they just won’t listen.
There are empathetic, actionable ways to support someone with an alcohol use disorder (AUD) who may be stuck in denial.
People who are high functioning with a drinking problem “seem to have everything together,” says Matt Glowiak, PhD, LCPC, a certified advanced alcohol and drug counselor. They’re able to successfully manage tasks around their work, school, family, and finances, he says.
But maybe they drinka few glasses of wine each night to help them fall asleep. Or, they get bombed every weekend but don’t skip a beat at their demanding job.
Yet, cracks start peering through.
“The main differences with high-functioning people with substance use disorder is that it usually affects their relationships first and their job last,” says Lauren Grawert, MD, a psychiatrist at Kaiser Permanente in Virginia.
“For example, you may notice your spouse drinking more beers at dinner, sleeping less and less, and increasingly on edge well before they start missing workdays,” Grawert adds.
According toVanessa Kennedy, PhD, director of psychology at Driftwood Recovery, other high-functioning examples include:
- a stay-at-home parent keeps up with their kids’ activities, but drinks more than they intended and gets irritable when they can’t drink
- a high-performing sales exec continually gets behind the wheel after several drinks
- a retiree drinks throughout the day, particularly when operating potentially dangerous power tools
In short, “there’s not a single image of AUD,” points out Sabrina Spotorno, a clinical social worker and alcoholism and substance abuse counselor at Monument.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the diagnostic criteria for AUD features 11 symptoms, including:
- drinking more than intended
- trying to cut back but not being able to
- letting alcohol consume your days
- having an unrelenting craving for alcohol
- not being able to meet social, home, or work obligations
- experiencing relationship problems
- developing health or mood complications, such as anxiety and depression
- engaging in risky behavior, such as drinking and driving
- developing a tolerance to alcohol
- avoiding important activities in order to drink
- experiencing withdrawal symptoms, such as sleeping problems, shakiness, or a racing heart
Depending on the number of symptoms, their AUD may be:
If your loved one is in denial or doesn’t want to seek treatment, they’re not alone. According to the
According to Kennedy, when someone doesn’t realize they have a drinking problem, they may:
- Minimize the impact: “Everybody has to call in sick because of a hangover sometimes,” or, “It’s not like I ever drive home drunk; I always call an Uber.”
- Shift the blame: “If my boss wasn’t such a jerk, I wouldn’t need to drink to unwind,” “My daughter’s behavior problems are so stressful that I don’t know how else to relax,” or “I need a drink to deal with my family!”
- Make comparisons: “I’m nothing like Uncle Larry, he’s had a DUI and I’ve never seen him without a drink in his hand.”
- Skip meals: This way, alcohol hits them harder.
- Try unsuccessfully to cut back: One glass inevitably turns into more.
People in denial might also point out their past and current accomplishments as signs that they’re perfectly OK, says Glowiak: “How can I possibly get my kids to school and successfully run my business if I have a drinking problem?”
To save face, Glowiak says, people with an AUD might:
- drink in private
- hide empty containers
- make attempts to cover their breath
- pace their drinking so they’re buzzed but not “drunk”
What might look like denial may actually be a lot more complicated and multilayered for people with high-functioning AUD.
“For starters, the media, our workplaces, and many social circles normalize drinking to excess,” says Ruby Mehta, a clinical social worker and director of clinical operations at Tempest.
“In some families, drinking too much is seen as comical, not a big deal, or a must during celebrations,” she adds. Consequently, many people may not realize their drinking has become a genuine problem.
Even if you are aware that your drinking has become a problem, it’s common to worry about what others might think. In a
“AUD is one of the only disorders that you get yelled at for having,” points out Eileen Conroy, a mental health specialist with Beyond Anxiety. “It’s often misperceived as a personality flaw, and this lack of understanding and empathy breeds judgment and criticism — which people pick up on.”
According to Conroy, it may be easy to get caught in denial with AUD if you subconsciously feel something is wrong with you at your core. It also might mean admitting that they don’t have it all together, and their exterior (and interior) world is crumbling.
Grawert adds that in communities of color, “mental health and addiction treatment carries even more associated stigma.”
Another major deterrent for some people may be chemical dependence.
According to Spotorno, “With time, the brain stops just associating alcohol with pleasure or relaxation, and can begin to recognize alcohol consumption as required for basic functioning. Because of this, drinking can feel innate, which makes it harder to recognize the need to make a change.”
Sometimes, a person’s personality can influence their tendency for denial. Certain traits, such as independence and perfectionism, can add to a person’s hesitancy or reticence to seek help, says Grawert.
All experts agree that when talking to your loved one, it’s best to be patient and compassionate.
“Always approach a loved one from a place of support and desire to help them, instead of leading with judgment or anger,” says Omar Elhaj, MD, a senior medical director at LifeStance Health.
Anger and frustration can be tough emotions when supporting someone with AUD. Reminding yourself that you can’t “fix” your loved one — but you can be there for them — can help you cool off, says Elhaj.
According to Mehta, it’s also helpful to remember that your loved one may be experiencing shame and fear, which can lead to feeling defensive or hesitant.
“For the conversation to go smoothly, it’s a good idea to get the individual’s permission to discuss,” says Grawert, such as saying:
- “Is it OK if we talk about your relationship with alcohol? I’m worried and would like to get your thoughts.”
- “I’ve been thinking about you and alcohol. Can we talk more about this?”
Or try this conversation starter from Mehta: “I wanted to talk to you about something because I care about you so much. And I’d hope if you saw me struggling with something you’d offer to help me, too.”
What if your loved one refuses?
Grawert advises against pushing. Instead, she recommends seeking more formal support with Al-Anon or therapy to help you create boundaries and care for yourself.
Name what you’re seeing
Bring up the specific behavior that needs support, says Mehta, such as:
- “I noticed that you blacked out the last few times we went out.”
- “I noticed that you weren’t feeling well after drinking the last few weekends.”
Reiterate your concern
According to Mehta, you might say:“I care about you and I want to be there for you, just as I’d want you to be there for me.” The latter “shows them that you respect them and aren’t patronizing them.”
Communicate your boundaries
Don’t discount your own well-being. To set your boundaries, Kennedy and Mehta suggest saying:
- “I am so concerned about your drinking that I don’t want to enable the behavior. So I’m not going to buy alcohol for you, or cover for you anymore when you miss family events.”
- “I want to be there for you. But at this time, it’s too difficult for me to be there when [unhealthy behavior] is happening. I’m here for you if you want someone to hang out with and do some activities not involving alcohol together or go to a recovery meeting together.”
Consider trying these additional actionable, empathetic strategies for your loved one and yourself.
Ask about their support needs
Inquire about the best ways you can support them in getting help and offer some tangible ideas.
According to Mehta, you might:
- research online treatment resources
- attend a support group together
- text them when they’d normally want to drink
- invite them to an alcohol-free activity over the weekend
Consider not drinking yourself (at least temporarily), says Kennedy. You, too, might realize that your relationship with alcohol is negatively affecting your life. And you might find that you feel healthier and happier without it.
“Mental health care is critical for achieving long-term success in overcoming AUD,” says Elhaj.
“People may experience an unhealthy relationship with alcohol for many different reasons. Just like any other condition or illness, addressing it head on with a professional is an important step to getting healthy.”
Prioritize your needs
Consider seeing a therapist or joining a support group. In addition to supporting your own mental health, this serves as a role model to your loved one.
“When you take steps to heal, it gives everyone permission around you to do the same,” says Spotorno.
It’s hard watching a loved one deny their drinking problem. But in reality, denial is complex. There may be many reasons why someone is hesitant to seek help — from lack of awareness to stigma and shame.
So, when supporting your loved one, it can be beneficial to lead with love, compassion, and understanding. If they’re not receptive, keep trying — and set boundaries to protect your own well-being.
Treatment can take many forms. It may involve completely quitting alcohol or cutting back on alcohol.
Recovery support groups can be a great place to start:
- Alcoholics Anonymous (AA)
- Moderation Management
- Smart Recovery
- Recovery Dharma
- “Quit Like a Woman” by Holly Whitaker
- “This Naked Mind” by Annie Grace
- “The Unexpected Joy of Being Sober” by Catherine Gray
For emergency support, contact the SAMHSA National Hotline at 800-662-HELP (4357).
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